International Conference on Family Planning 2009

Family Planning: Research and Best Practices

Are Hormonal Contraceptives Safe for HIV+ Women?

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Until recently, a dearth of data has made it difficult to counsel HIV-infected women about contraceptive options. In Africa, where the preferred birth control products are hormonal contraceptives such as pills and injectables, there has been some question about whether these methods would have an adverse effect on women who are already infected with HIV.

When Chelsea Polis, who just finished her doctoral degree at the Johns Hopkins Bloomberg School of Public Health, sought to answer this question, she found inconclusive research. Almost a dozen observational studies have provided mixed evidence, and the data’s validity is questionable. To design a new data collection effort, she would need to track women from the time of HIV seroconversion until they presented with AIDS or until they died—this could take 10 years or more. Fortunately, she Rakai Community Cohort Study had all the necessary data.

Using the wealth of data from the Rakai study, Polis found that hormonal contraception appears to be safe for use in HIV-infected women; HIV did not progress any faster in women who used the hormonal methods than it did in those who use other methods.

This finding provides good news on two fronts: family planning and HIV prevention. On the first front, HIV-infected women who wish to prevent pregnancies may now be soundly counseled that hormonal contraceptives are safe to use. The second ramification is that, in preventing unintended pregnancies in HIV-infected women, there are fewer babies born at risk of acquiring HIV through exposure in utero or through breastmilk—and thus HIV prevention is increased. Bolstering that good news is the fact that hormonal contraception as a means of preventing the spread of HIV is significantly more cost-effective than the HIV prevention strategy that involves providing pregnant, HIV-infected women with antiretroviral therapy prophylaxis.

In this case, contraception meets not only family planning needs, but supports HIV prevention efforts.

Written by C. Grillo | JHSPH

November 17, 2009 at 8:29 pm

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